| Objective:This study conducted a Meta-analysis of clinical RCT literature on the treatment of CKD with the method of tonifying the kidney and activating blood.Through clinical controlled trials,the evaluation is based on the management of chronic diseases of traditional Chinese medicine by activating kidney and enriching blood in the intervention of patients with chronic kidney disease in stages 3 to 4.It hopes to provide a reliable clinical basis for the treatment of this disease by the method of invigorating the kidney and activating blood from the perspective of evidence-based medicine,and to explore advantages of chronic disease management of traditional Chinese medicine in delaying the progression of nephropathy,and to provide guidance and approaches for clinical application.Method:1.According to the developed search strategy,the RCT literature of CKD treatment of therapy of tonifying Kidney and activating blood circulation was fully retrieved in the Chinese and English databases,and the resulting literature was imported into Note Express for screening.The literature was evaluated for methodological quality through the Cochrane and JADAD scales,and the data extracted from the literature were meta-analyzed through Revman 5.3 and Stata 16.2.The cases were selected from 64 patients with chronic kidney disease stage 3 to 4diagnoses who were diagnosed in the nephrology department and ward of the Affiliated Hospital of Tianjin Academy of Traditional Chinese Medicine from October 2019 to June2020.The chronic disease management plan is divided into observation group and control group.The control group was given a basic treatment plan based on the method of invigorating the kidney and promoting blood circulation,and the observation group was added with the chronic disease management plan of traditional Chinese medicine on the basis of the control group.The observation period was 6 months.The clinical data of the patients were collected,through the SF-36 scale,BMI,TCM syndrome scores and laboratory indicators: serum creatinine,hemoglobin,the clinical efficacy,quality of life and quality of life of the two groups of patients before and after treatment were analyzed.Improvement of clinical symptoms in Chinese medicine.Data analysis was performed by SPSS21.0 software,and P<0.05 was considered statistically significant Result:1.(1)This study searched the above databases,collected 549 literatures,and finally after screening 15 RCT studies into meta analysis,of which only 7 high-quality studies,the overall quality is not high.Sample sizes ranged from 50 to 171,with a total of 1,216 patients.(2)Meta-analysis showed that the treatment group using combined treatment of western medicine and TCM therapy by tonifying kidney and activating blood circulation had better clinical efficacy compared with the western medicine control group[RR=1.29,95%CI(1.21,1.39),P<0.00001],which had advantages in decreasing Scr [MD=-19.67,95%CI(-23.65,-15.69),P<0.00001],BUN[MD=-1.05,95%CI(-1.45,-0.65),P=0.004],24-hour urine protein quantification[MD=-0.16,95%CI(-0.25,-0.07),P=0.0007],increasing e GFR[MD=6.28,95%CI(4.87,7.70),P<0.00001],increasing plasma albumin[MD=3.94,95%=CI(0.29,7.60),P=0.03],improving Hb[MD=5.84,95%CI(1.36,10.32),P=0.01]and improving TCM syndrome score[MD=-4.24,95%CI(-5.68,-2.81)P<0.00001].2.By the end of the observation period,2 cases fell off in the observation group(1 case did not take medicine as required,1 case lost follow-up).Finally,30 patients in the observation group and 30 patients in the control group completed the whole follow-up period and were included in the statistics.Statistical result:(1)The effective rate of clinical curative effect in the observation group was 93.3%;the effective rate of clinical curative effect in the control group was 86.7%(P>0.05);(2)Scr decreased in both groups(P>0.05);(3)Hb increased in both groups,the observation group was significantly higher than the control group(P<0.05);(4)Compared before and after treatment in the two groups of BMI,the decrease in the control group was not statistically significant(P>0.05),After treatment,the observation group was significantly lower than the control group(P<0.05);(5)The scores of TCM syndromes decreased in each of the two groups.The difference in the total scores of the two groups was poor appetite,waist and knee weakness,nausea,heavy limbs,edema,low back pain,clear night urine,numbness,and total symptoms,the observation group has a more obvious decline than the control group(P<0.05);(6)Comparison of the quality of life score before and after treatment in the group,the physiological function of the control group and the physiological function of the two groups were not statistically significant before and after treatment(P>0.05),and the differences in the other quality of life scores before and after treatment were statistically significant(P<0.05),which were significantly increased after treatment;the two groups had statistically significant differences in physiological function,general health,energy,social function,emotional function,and mental health after treatment(P<0.05),and both were significant in the observation group it was higher than that of the control group,but there was no statistically significant difference in physiological function and physical pain between the two groups after treatment(P>0.05).Conclusion:1.Compared with the treatment of Western medicine,the method of invigorating the kidney and activating blood has more obvious advantages in clinical efficacy,reducing Scr,BUN and reducing 24 h proteinuria,increasing Hb,glomerular filtration rate and plasma albumin levels,and improving TCM syndrome integration.It shows that the method of invigorating the kidney and promoting blood circulation is an effective measure to treat chronic kidney disease,and it is worthy of in-depth research.Because the overall quality of the included literature is undergrade,the efficacy and safety of the method of invigorating the kidney and activating blood in the treatment of chronic kidney disease need to be further confirmed by randomized controlled trials with longer design cycles,larger samples,and more rigorous.2.On the basis of the method of invigorating the kidney and promoting blood circulation,the chronic disease management of traditional Chinese medicine can significantly increase Hb,improve BMI and clinical symptoms of traditional Chinese medicine,improve the quality of life of patients,and delay the progression of CKD. |
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